Do Hospitals Get Emergency Medical Services Patient Care Reports?
Annals of Emergency Medicine
Objectives: EMS Patient Care Reports (PCRs) are an important component of the EMS system, patient care, and a foundational element of EMS quality improvement (QI). In many cases, PCR documentation provides handoffs between care providers, and may serve as the only objective context for patient presentation. This is especially evident when patients have altered mental status, are unreliable historians, or their caretakers are not immediately available for interview. Little data exists regarding the frequency and timeliness of PCR provision to emergency departments (ED). Our objective is to describe the frequency of missing PCRs following EMS transport and the timing of their receipt by EDs within a regional health care system. Methods: We performed a retrospective study of EMS PCRs for patients transported to a single health system from 1/1/21 – 7/1/22. This healthcare system includes eight acute care hospitals in Southeast Michigan, which received 541,486 ED visits during that timeframe. EMS Agencies who transported <100 patients were excluded. PCRs are transmitted by fax to ED or e-fax to Non-EPIC® server and manually uploaded into the system’s EMR. We stratified agencies by whether they provided primary 911 response or interfacility transport. PCR receipt and time of EPIC upload were obtained from EPIC Crystal Report® query. Our primary outcome was frequency of PCR receipt by EDs (in aggregate and by agency). Our secondary outcome was interval from EMS ED arrival to EMR upload. We dichotomized that interval as greater or less than 120 minutes of arrival. We provide descriptive statistics reporting proportion of receipt of PCR (mean, range) by hospital and agency. Results: There were 106,496 patients transported by 62 agencies, with 87.3% being primarily 911 responding agencies. Overall, receipt of PCRs varied substantially by hospital – 54.2% (13.5% - 80.1%) (Table 1). Of those submitted, 30.7% (2.4% - 63.4%) were uploaded within 120 minutes of ED arrival. PCR submission rate also varied substantially by agency, 45.8% (2.5% - 96.8%). Interfacility EMS services were far less likely to submit a PCR after ED transport (35.9% vs. 56.9%). Conclusions: Completed PCR’s are frequently missing after EMS transport to ED’s within this large hospital system, and infrequently available for review in a timely manner. Interfacility transport agencies are less likely to provide PCRs compared to 911 responders. Although hospital manual upload of PCRs may impact time of their receipt, this does not explain the overall rate of missing PCRs. Further work is needed to identify obstacles to PCR delivery and assure their availability for ED care of EMS patients.
Shanley J, Marcero J, Swor R. Do hospitals get emergency medical services patient care reports? Ann Emerg Med. 2023 Oct;82(4 Suppl.):S91. doi:10.1016/j.annemergmed.2023.08.219